Pandemic. The word describes maladies that
aren’t just regional in scope (epidemics) but those with a global
impact. Of the great pandemic diseases of the Middle Ages, plague,
St. Anthony’s fire, leprosy, and typhus are now uncommon. What
survives? Influenza. Fortunately, it’s the mildest of these
infectious diseases. Even so, during the flu outbreak of 1918,
about 20 million people (including more than 500,000 Americans)
died from the disease. Now, when influenza strikes, far fewer
people die, largely because of modern medicine’s ability to control
During the Middle Ages, people called the disease influenza
coelestia, reflecting the belief that heavenly bodies and natural
disasters strongly influenced the affairs of humankind. Now we know
the enemy is an invisible one: the influenza virus. The most common
types are A and B. This virus is transmitted through the air, such
as when someone sick coughs or sneezes. Other respiratory viruses
such as parainfluenza can produce flu-like symptoms. Those symptoms
include teeth-rattling chills, headache, muscle aches, malaise,
poor appetite, runny nose, sore throat, and cough. Because
resistance is lowered, bacterial infections such as sinusitis,
middle ear infection, and pneumonia may follow.
Prevention: Fending off the flu
How can you avoid getting the flu? You could scrupulously avoid
contact with anyone who has it. But given how common and how highly
contagious the virus is, such a strategy is impractical, unless
you’d like to become a hermit during the winter months. The
keystone of prevention is a healthy immune system. Francis Brinker,
N.D., botanical medicine preceptor at the Program in Integrative
Medicine at the University of Arizona in Tucson and the author of
Formulas for Healthful Living (Eclectic Medical, 1998) and Herb
Contraindications and Drug Interactions (Eclectic, 1998), has
“To prevent flu, the focus should be on a balanced lifestyle:
good nutrition—whole grains, beans, fruits and vegetables, and
water—and elimination, plus ample exercise, sleep, relaxation,
social interaction, private time, recreation, and spirituality,” he
Conventional preventive treatment lies in vaccinating against
influenza. The Centers for Disease Control and Prevention recommend
vaccination for people at a high risk for complications (see box at
right for examples). Each year, researchers include in the vaccine
the strains of influenza that are most likely to strike. Although
about 25 percent of people report soreness at the injection site,
severe reactions to these vaccines are rare. A vaccine that is
given as an intranasal spray is nearing approval in the United
States. Several studies involving children and adults show that
it’s safe and effective. The main side effect is mild cold-like
symptoms in 10 to 15 percent of recipients.
Because a full immune response to the vaccine takes two to four
weeks to develop, the ideal time to get a flu vaccine is
mid-October to mid-November. In the Northern Hemisphere, flu season
usually lasts from December to March.
Herbal prevention—building immunity
If you have a weakened immune system, herbal immune tonics may
help. These tonic herbs can be taken daily and at low doses during
the flu season to support immune function and minimize your
Astragalus (Astragalus membranaceus) has a 2,000-year track
record in China. Studies have demonstrated the herb’s
immune-boosting, antiviral, antibacterial, and anti-inflammatory
effects. Root extracts even improve immune function among cancer
patients whose immune systems are depressed by chemotherapy.
Practitioners such as Christopher Hobbs, L.Ac., A.H.G., recommend
it to people whose weakened immune system makes them prone to colds
“Astragalus is an immune-booster that is most often used in a
traditional formula with similar herbs such as atractylodes,
licorice, and privet berries to create a balanced effect,” he says.
He recommends astragalus be taken as a preventive measure or after
the illness has passed to help restore proper immune function.
“The traditional way of using this herb is in teas, powdered
extracts in capsules and tablets, and in syrups,” Hobbs says. “The
effectiveness of astragalus’ polysaccharides, the main
immune-boosting constituents, is reduced by alcohol.”
Michael Castleman, author of The New Healing Herbs (Rodale,
2001) and many other books, likes to take this herb as a tea. To
make the tea, finely chop four or five astragalus sticks and simmer
them in 4 cups of boiling water for 1 hour. Drink 1 cup in the
morning and afternoon. When making soup, place four sticks in a
1-quart pot and remove the sticks before serving. For the best
effect, Hobbs advises taking about 6 to 12 g of this herb daily for
one to three months.
Siberian ginseng (Eleutherococcus senticosus), also called
eleuthero, and Asian ginseng (Panax ginseng)—though better known as
herbs to help the body cope with stress—both have beneficial
effects on the immune system. Hobbs finds eleuthero particularly
helpful for people under stress, especially those whose stress
leads to repeated bouts of cold and flu.
In a 1987 German study, healthy volunteers took 10 ml (2
teaspoons) of an alcohol extract of eleuthero three times daily for
four weeks. Compared to the placebo group, those taking eleuthero
had increases in immune cells, including the type of cell that goes
after viral infections.
Daily consumption of ginseng is generally recommended only for
people over the age of forty. “People under forty can use Asian
ginseng if they have reduced digestive vitality and fatigue
accompanied by coldness, not heat,” Hobbs says. In test-tube
studies, Asian ginseng activates infection-fighting immune cells,
including the types of cells essential in combating viral
infections. One study found that Asian ginseng and Echinacea
purpurea enhanced immune function in both normal people and in
those with depressed immunity.
In a 1996 Italian study, researchers found that taking 100 mg of
standardized ginseng extract daily for twelve weeks improved immune
response to the flu vaccine. Compared to the placebo group, the
ginseng group also had nearly two-thirds fewer attacks of both
influenza and the common cold.
Shiitake mushroom (Lentinula edodes) is revered in China and
Japan as both a culinary delicacy and a medicine. Its active
ingredients have immune-enhancing and antiviral effects. Animal
studies show protection against influenza infection. During the
winter months, you can sauté this tasty mushroom and add it to all
kinds of foods, including soups. Hobbs, author of Medicinal
Mushrooms (Botanica, 1996), says, “One or two fresh shiitakes will
confer a good immune-modulating effect, especially for prevention
of disease, but the dried extract is often preferred by
practitioners because it is much more concentrated and can offer
additional immune effects, especially when taken daily over one to
three months.” Follow the manufacturer’s dosage guidelines.
Nipping illness in the bud
Conventional treatment for influenza is expensive and generally
reserved for people at high risk for severe disease. The first
anti- influenza drugs—amantadine (Symmetrel) and rimantadine
(Flumadine)—hasten recovery from type A influenza. Side effects
include anxiety, depression, and insomnia.
Newer drugs, such as oseltamivir (Tamiflu) and zanamivir
(Relenza), inhibit both influenza A and B. The former is available
in pill form; the latter is used as an inhaler. Oseltamivir’s side
effects include nausea and vomiting. Side effects from zanamivir
are minor and uncommon.
To be effective, all of these drugs must be taken within the
first two days of symptom onset. Used in this way, the drugs tend
to shorten the length of illness by one to one-and-a-half days.
Among high-risk, unvaccinated people, especially those exposed to
someone with influenza, these drugs can also be used to prevent
illness. Antibiotic use is unwarranted because antibiotics kill
bacteria, not viruses.
Herbal remedies, on the other hand, are safe and relatively
inexpensive. Furthermore, scientific studies support the wisdom of
centuries of traditional use.
Echinacea (Echinacea spp.) has become a popular remedy for
nipping colds and flu in the bud. “I keep echinacea in the house at
all times,” Castleman says. “When I think I have the flu, I start
taking it immediately.” Research supports its use in reducing
symptom severity and duration. Studies investigating its
effectiveness in preventing respiratory illness have yielded mixed
results. In a 1999 research review published in the Journal of
Family Practice, eight of the nine clinical trials that used
echinacea to treat upper-respiratory infections were deemed
effective, whereas three of the four trials using echinacea to
prevent infection showed only marginal benefit.
What’s confusing about echinacea is that there are three main
species and several means of preparing the herb: alcohol tinctures
of the root, fresh-expressed juice from the above-ground parts
(leaves, stems, and flowers), teas of the root or above-ground
parts, capsules and tablets of the dried above-ground parts, and
standardized extracts. In 1996, one of the leading echinacea
researchers, Rudi Bauer, Ph.D., of the Institute for Pharmaceutical
Biology at Heinrich-Heine University in Düsseldorf, Germany,
reviewed twenty-three studies and determined that two types of
preparations have been shown effective in both test-tube and human
studies. These were the juice of the above-ground parts of E.
purpurea (marketed as Echinacin in Europe and Echinagard in the
United States) and the alcoholic extracts of the roots of E.
pallida, E. angustifolia, and E. purpurea. (See “What about
standardized echinacea?” on page 41 for more information.)
Teas may also be effective. An American study published in the
August 2000 issue of the Journal of Alternative and Complementary
Medicine found that ninety-five people with the beginnings of a
cold or flu found significantly greater relief from drinking 5 to 6
cups a day of an echinacea tea called Echinacea Plus than from a
placebo. (Echinacea Plus is a proprietary blend—made by Traditional
Medicinals—of the above-ground parts of E. angustifolia and E.
purpurea, a water-soluble dry extract of E. purpurea root, plus
lemongrass and spearmint leaf.)
To see benefits from echinacea, you need to take an adequate
dose. One study found that 900-mg daily doses (180 drops of root
tincture) proved effective in treating flu-like infections; the
450-mg dose (90 drops) had the same effect as a placebo. See the
box on page 40 for echinacea dosage guidelines.
Both the flowers and berries of black elderberry (Sambucus
nigra) are traditional flu remedies. This plant contains antiviral
substances with activity against influenza. The berries contain
anthocyanins, purple plant pigments that enhance immune function
and have potent antioxidant activity. Theoretically, antioxidants
may help control some of the tissue damage caused by the
inflammation that accompanies flu.
Several studies have investigated the flu-fighting benefits of a
proprietary extract of elderberries called Sambucol. In a 1995
Israeli study, researchers first demonstrated that this extract
inhibited both type A and type B influenza viruses. The researchers
then took forty people with new onset of flu and gave half of the
group a placebo and the other half the elderberry syrup. For three
days, children took 2 tablespoons and adults took 4 tablespoons of
the syrup daily. Complete cure occurred in nearly 90 percent of
people within two to three days for the elderberry group versus at
least six days for the placebo group.
In a second clinical study conducted in Norway, sixty people
with influenza took either Sambucol or a placebo, 1 tablespoon four
times a day for five days. Again, the elderberry extract
significantly reduced the duration of flu symptoms. The people
taking elderberry required less analgesic medication and nasal
spray to control symptoms.
Garlic (Allium sativum) stimulates the immune system and fights
a broad range of microbes, including viruses. Test-tube studies
show that garlic is active against some of the viruses that cause
flu-like illnesses and colds. Garlic’s compound allicin has been
credited with this antimicrobial power. Our bodies partially
eliminate garlic across the lungs (hence the famous “garlic
breath”), which is a boon when you’re suffering a respiratory
infection. Plus, garlic promotes expectoration, to help get rid of
Castleman says that when it comes to fighting the flu, raw
garlic is best. “The herb must be chewed, chopped, bruised, or
crushed to transform its medicinally inert alliin into antibiotic
allicin,” he says. Castleman recommends taking a couple of cloves
two to three times a day. When I suspect I’m coming down with the
flu, I blend two raw garlic cloves with a glass of orange juice and
a pinch of cayenne and drink this concoction twice a day. You can
also blend minced garlic into dips, dressings, sauces, and sandwich
Castleman also makes a tincture by soaking 1 cup of crushed
garlic cloves in 1 quart of brandy. Shake daily for two weeks,
strain, and take up to 3 tablespoons a day. If you don’t like the
aftereffects of fresh garlic, try tablets of deodorized garlic
instead—just follow the package instructions.
Licorice root (Glycyrrhiza glabra) stimulates the body’s
production of interferon, an antiviral compound. Licorice’s
glycyrrhizic acid fights a range of viruses, including influenza
virus. The herb also has antioxidant, anti-inflammatory, demulcent,
and expectorant properties. These combined properties make licorice
a one-stop-shopping herb for illnesses marked by a sore throat and
Licorice, unless you don’t care for its sweet taste, blends well
with other respiratory herbs and can help mask bitter tastes. A
little goes a long way, so simply add a pinch (1/8 teaspoon) of
ground root to other herbs when you brew a cup of tea. If you
prefer a licorice tincture, herbalist Steven Foster recommends 20
to 30 drops three times a day. Caution: Licorice is not recommended
for pregnant women or people with high blood pressure, diabetes, or
disease of the thyroid, kidney, liver, or heart. Because licorice
prolongs the life of corticosteroid medications, consult with a
doctor before using it medicinally. Because of the potential for
elevated blood pressure and lowered potassium levels, other people
(especially women taking oral contraceptives) should not take
licorice continuously for more than four to six weeks, unless
monitored by a health practitioner.
Symptom relief—if the flu’s already got you down
Conventional treatment consists chiefly of over-the-counter
analgesics, antihistamines, decongestants, expectorants (to help
expel mucus), and cough suppressants. Side effects include stomach
irritation with many analgesics, drowsiness and dry mouth and nose
with antihistamines, and jitteriness and insomnia with
decongestants. Avoid cough suppressants (usually dextromethorphan)
when a cough is productive (wet), because suppressants interfere
with the body’s clearance of infected secretions.
Basic home care. Drink lots of warm liquids (to soothe a sore
throat and loosen respiratory mucus), inhale steam (to help loosen
and expel respiratory mucus), take warm herbal baths, bundle up in
bed, and rest.
Herbal remedies. For body aches, boneset (Eupatorium
perfoliatum), according to Brinker, is one of the most useful herbs
for reducing the achiness that accompanies the flu. Europeans, he
says, often combine boneset with echinacea and baptisia (Baptisia
tinctoria) in a tincture. A traditional flu tea blend is 2 parts
boneset flowers and leaves, 1 part elder flowers (Sambucus
canadensis or S. nigra), and 1 part peppermint (Mentha ¥piperita)
leaves. Use 1 teaspoon of this mix per cup of boiled water, steep
for 10 to 15 minutes, strain, and drink 3 to 4 cups daily.
Otherwise, you can take boneset tincture, 20 to 30 drops, three
times a day. For the European tincture combo, Brinker says to take
10 to 15 drops of boneset, 10 to 15 drops of baptisia, and 20 to 30
drops of echinacea three times a day. Caution: Used in large
amounts, boneset can cause nausea, vomiting, diarrhea, and may
damage the liver. Pregnant women should not take it.
Ginger (Zingiber officinale) has mild analgesic effects.
Castleman adds that Indian studies demonstrate immune- boosting
effects and Chinese studies indicate this herb helps kill the
influenza virus. Use fresh gingerroot in cooking or drink 2 cups of
tea daily. Castleman’s tea recipe is to add 2 teaspoons of powdered
or freshly grated root per cup of boiling water, steep for 10
minutes, strain, and drink. Brinker likes to add lemon to his
For headaches, try feverfew (Tanacetum parthenium), ginger, or
For fevers, diaphoretic herbs promote sweating, which helps to
lower body temperature. Time-honored diaphoretics include elder
flower, yarrow (Achillea millefolium), peppermint, catnip (Nepeta
cataria), and boneset. A classic tea recipe is to blend equal parts
of elder flowers, yarrow flowers, and peppermint. Steep 1 to 2
teaspoons per cup of boiled water for 10 to 15 minutes, strain, and
drink as much as you want.
For sore throats, try demulcent herbs—licorice root, marshmallow
root (Althaea officinalis), plantain leaf (Plantago officinalis),
and mullein leaves and flowers (Verbascum spp.).
For coughs, use demulcents (discussed above) to soothe dry
coughs. Try expectorants—mullein, elecampane (Inula helenium),
garlic, licorice, horehound (Marrubium vulgare), hyssop (Hyssopus
officinalis), and lobelia (Lobelia inflata)—to help clear mucus.
Antispasmodics—thyme (Thymus vulgaris), lobelia, ginger, and
hyssop—help calm coughs. Wild cherry bark (Prunus serotina) is a
natural cough suppressant, but don’t use it if your cough is
Linda B. White, M.D. is coauthor of Kids, Herbs, & Health
(Interweave, 1998) and The Herbal Drugstore (Rodale, 2000).
The reference list for this article is extensive. If you would
like a copy, please send a self-addressed, stamped envelope to
“Flu,” Herbs for Health, 243 E. Fourth St., Loveland, Colorado
80537, or e-mail us at HerbsForHealth@HCPress.com.