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Treatment and Prevention of H1N1 Swine Flu

By Jake Paul Fratkin, OMD, LAc
 
As the H1N1 swine flu sweeps across the world, it is important to keep several things in mind. First of all, while all flu is deadly, this one appears milder in symptoms and duration than the common flu.1 What distinguishes H1N1 is that it is highly contagious, and those who are getting sick are children and young adults. 
 
It seems to be epidemic in the middle- and high-school age range. My experience is that this flu easily develops into a harsh-cough stage.

Traditional 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 herbal doctors or self-medicate with recommended herbal products. As H1N1 spreads widely throughout China, millions of people are taking these recommendations.2

Understanding the H1N1 Swine Flu

When a flu virus cross mutates between birds and mammals (such as pigs), and then further cross-mutates within a human host, the result can be the creation of a virulent strain of flu that overwhelms one's natural immune response. Avian-swine flu is the result of mutations between several different kinds of animal species. There have been several times in the last 100 years when an avian strain has further mutated within human hosts. This type of flu tends to be more virulent and contagious with more severe symptoms.

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, cough, headache, and muscle or joint pains. The main symptoms are fever (101-103°F) with chills or shivering, and headache.

China's Recommendations

During the 2003 SARS epidemic, 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 with damp-heat, but the observations and recommendations made for SARS still apply for lung wind-heat. Wen bing formulas are recommended, but with the addition of herbs showing strong antiviral effect.3

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). There were also recommendations for unusual 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 health ministries and individual hospitals have issued guidelines for both treatment and prevention of flu.4 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.5 Both Yin Qiao San and Sang Ju Yin were invented and recorded by Wu Ju-Tong in 1798 as part of the wen bing (warm diseases) movement.6

The following formula was generated during the SARS epidemic.7 The original Sang Ju Yin formula uses sang ye (Folium mori albae), ju hua (Flos chrysanthemi morifolii), lian qiao, 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, huang qin (Radix scutellariae) and huang qi (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, ban lan gen, bo he and gan cao.

Another slightly larger formula recommends chuan xin lian, yi yi ren (Semen coicis lachryma-jobi), guan zhong, lian qiao, jin yin hua and hu zhang. Other herbal prescriptions are also reported.8  Besides recommending herbal decoctions and powders, the Chinese authorities also recommend various prepared products such as Gan Mao Ling, Zhong Gan Ling and Ban Lan Gen Chong Ji for acute symptoms.9

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, huang qin 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, lian qiao, bai zhu (Rhizome atractylodes macrocephala), dan zhu ye (Folium lophatheri), lu gen, yu xing cao (Herba houttuyniae), jin yin hua, ge gen, ju hua, fang feng (Radix ledebouriellae divaricatae), bo he and gan cao.

Prevention. For flu prevention, the recommended approach has been an adjusted Yu Ping Feng formula, adding in antiviral herbs. The original formula, dating back to 1481, supports the immune system by boosting both ying and wei qi.10 Antiviral herbs are added.11 The prescription, called "Flu Prevention Formula," formulated and issued by the Committee of Experts for Flu Prevention and Control under the Beijing Administration of Traditional Chinese Medicine, follows this approach.12 The herbs used are huang qi (Radix astragli), bai zhu, fang feng, guan zhong, jin yin hua and chen pi (Pericarpium citrus reticulata).

Based on Chinese recommendations, I have also 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. It consists of huang qi, tai zi shen (Radix pseudostellaria heterophylla), fang feng, bai zhu, lian qiao, ban lan gen, huo xiang (Herba agastaches seu pogostemi), ju hua and gan cao.

Herbal Product Recommendations

Chinese herbal products: For illness, alternate Gan Mao Ling and Zhong Gan Ling, taking one of them every three hours.13 Both are commonly available from various manufacturers. If harsh cough develops, add formulas that clear lung fire.14 For prevention, use Yu Ping Feng San, also known as Jade Screen. My formulas, Clear Toxin and Immune Plus are also available to practitioners.

Support: Oscillococcinum (Boiron) is 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 one to two hours. As a preventative, take once daily.

The D3 formula of vitamin D promotes natural killer cells for attacking virus. Take 5,000 units daily for prevention, and 10,000 units a day if sick. This is the single best prevention against flu.

A longer article on this subject can be found on my Web site at www.drjakefratkin.com.

 
 
 

Early lessons from the H1N1 pandemic: Critical illness in children unpredictable but survivable

 
ontact: Ekaterina Pesheva
epeshev1@jhmi.edu
410-516-4996
Johns Hopkins Medical Institutions

Hopkins Children's experts describe first patients critically ill with H1N1

Lessons learned from the first 13 children at Johns Hopkins Children's Center to become critically ill from the H1N1 virus show that although all patients survived, serious complications developed quickly, unpredictably, with great variations from patient to patient and with serious need for vigilant monitoring and quick treatment adjustments.

These and other findings were published online on Dec. 31 in the journal Pediatric Critical Care Medicine, in what is believed to be the first published analysis of critical H1N1 illness in children.

The Johns Hopkins analysis shows that 12 out of the 13 very ill children had underlying medical conditions that made them more vulnerable, including sickle cell disease, asthma and HIV. Complications varied from temporary kidney failure to acute respiratory distress syndrome, dangerously low oxygen levels and dangerously low blood pressure.

An important finding was that rapid screening tests were initially negative in eight out of the 13 children, underscoring the need for more sensitive tests.

Therefore, researchers say, all critically ill children with flu-like symptoms regardless of test results should be treated preemptively with antiviral medications. Past research has shown that antiviral medications are most effective in healthy people with the flu if taken within 12 to 48 hours after symptoms begin. Johns Hopkins currently treats all hospitalized patients with unexplained fever and flu-like symptoms regardless of test results.

"Our most surprising, and perhaps most important finding, is that the H1N1 virus behaves unpredictably and variably from one patient to the other and even within the same patient from day to day, so we must be on our toes and react fast by adjusting therapy," says lead investigator Justin Lockman, a pediatric critical-care specialist at Johns Hopkins Children's.

Investigators caution that more and larger studies are needed to guide future practice and recommendations for H1N1 treatment in children.

"Our analysis did reveal some interesting patterns and trends, but it also showed us how much more we have to learn about the behavior of this new and intriguing virus," says senior investigator David Nichols, M.D., professor of anesthesiology/critical care and pediatrics at the Johns Hopkins School of Medicine.

The Hopkins team analyzed data from 140 pediatric patients diagnosed with H1N1 between June 2009 and August 2009, of whom 13 went on to develop critical illness and were admitted to the pediatric intensive care unit (PICU) at Hopkins Children's. The novel flu strain, originally called swine flu, emerged for the first time in April 2009.

Other findings reported in the article include:

  • Asthma was the most common underlying chronic condition (11 of the 13 children had it), followed by neuromuscular diseases like cerebral palsy.
  • Nearly half of the children became so sick they needed a ventilator to help them breathe. However, no children died or required ECMO (extra-corporeal membrane oxygenation), a last-resort critical-care device that takes over the patient's lungs and heart to oxygenate and circulate the blood when the patient's organs can no longer do so.
  • One-fourth of the children developed dangerous secondary bacterial infections, more often than previously believed, which points to the need for watchful monitoring for such infections in children with H1N1.
###

Co-investigators include William Fischer, M.D.; Trish Perl, M.D., M.Sc.; and Alexandra Valsamakis, M.D. Ph.D.; all of Hopkins.

Related on the Web:

H1N1 More Risky Than Seasonal Flu in Children with Sickle Cell Disease
http://www.hopkinschildrens.org/H1N1-Risky-for-Kids-with-Sickle-Cell.aspx

Flu Shots a Must for Kids With Sickle Cell Disease
http://www.hopkinschildrens.org/Flu_Shots_a_Must_For_Kids_With_Sickle_Cell.aspx

Infectious Disease Expert Discusses H1N1 in Kids; Quells Fears of H1N1 Vaccine
http://www.hopkinschildrens.org/newsDetail.aspx?id=7270

Risk of Serious Flu-Related Sickness in Pregnant Women Outweighs Risk of Injectable Vaccine
http://www.hopkinschildrens.org/Risk-of-Serious-Flu-related-Sickness-in-Pregnant-Women-Outweighs-Risk-of-Injectable-Vaccine.aspx

Parent's Guide to H1N1 (Swine) Flu
http://www.hopkinschildrens.org/flu-tips-for-parents.aspx